S. HRG.

109339

PREPARING EARLY, ACTING QUICKLY:

MEETING THE NEEDS OF OLDER AMERICANS
DURING A DISASTER

HEARING
BEFORE THE

SPECIAL COMMITTEE ON AGING

UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION

WASHINGTON, DC

OCTOBER 5, 2005

Serial No. 10915

Printed for the use of the Special Committee on Aging

(
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26545 PDF

2006

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SPECIAL COMMITTEE ON AGING

GORDON SMITH, Oregon, Chairman
RICHARD SHELBY, Alabama
HERB KOHL, Wisconsin
SUSAN COLLINS, Maine
JAMES M. JEFFORDS, Vermont
JAMES M. TALENT, Missouri
RUSSELL D. FEINGOLD, Wisconsin
ELIZABETH DOLE, North Carolina
RON WYDEN, Oregon
MEL MARTINEZ, Florida
BLANCHE L. LINCOLN, Arkansas
LARRY E. CRAIG, Idaho
EVAN BAYH, Indiana
RICK SANTORUM, Pennsylvania
THOMAS R. CARPER, Delaware
CONRAD BURNS, Montana
BILL NELSON, Florida
LAMAR ALEXANDER, Tennessee
HILLARY RODHAM CLINTON, New York
JIM DEMINT, South Carolina
CATHERINE FINLEY, Staff Director
JULIE COHEN, Ranking Member Staff Director

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CONTENTS
Page

Opening Statement of Senator Gordon Smith .......................................................

Opening Statement of Senator Elizabeth Dole .....................................................
Opening Statement of Senator Mel Martinez .......................................................
PANEL

1
3
4

OF WITNESSES

Keith Bea, specialist, American National Government, Government and Finance Division, Congressional Research Service, Washington, DC .................
Maria Greene, director, Division of Aging Services, Georgia Department of
Human Resources, Atlanta, GA ..........................................................................
Jeffrey Goldhagen, director, Duval County Health Department; and associate
professor of Pediatrics, University of Florida, Jacksonville, FL ......................
Leigh E. Wade, executive director, Area Agency on Aging of Southwest Florida, Inc., Fort Myers, FL .....................................................................................
Carolyn S. Wilken, Ph.D., M.P.H., associate professor and cooperative extension specialist, University of Florida, Gainesville, FL ......................................
Susan C. Waltman, senior vice president and general counsel, Greater New
York Hospital Association, New York, NY .........................................................

6
37
45
63
80
95

APPENDIX
Prepared Statement of Senator Herb Kohl ...........................................................
Additional material submitted by Carolyn Wilken ...............................................

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PREPARING EARLY, ACTING QUICKLY: MEETING THE NEEDS OF OLDER AMERICANS

DURING A DISASTER
WEDNESDAY, OCTOBER 5, 2005

UNITED STATES SENATE,

SPECIAL COMMITTEE ON AGING,
Washington, DC.
The committee met, pursuant to notice, at 10:30 a.m., in room
SH216, Hart Senate Office Building, Hon. Gordon Smith (chairman of the committee) presiding.
Present: Senators Smith, Dole, and Martinez.
OPENING STATEMENT OF SENATOR GORDON SMITH,
CHAIRMAN

The CHAIRMAN. Good morning, ladies and gentlemen. We welcome all of you to this hearing. Its entitled, Preparing Early, Acting Quickly: Meeting the Needs of Older Americans During a Disaster. It is probably one of the most important topics our committee will consider this year.
Over the last several weeks, we in Congress have devoted much
of our time to helping our fellow Americans who have been displaced by Hurricanes Katrina and Rita to get back on their feet.
We have also begun the long process of rebuilding those areas of
the Gulf region that have been so ravaged by these terrible storms.
Now that the work is underway, however, we must begin to examine the preparedness of our federal, state and local governments to
deal with such disasters in the future.
We will hear from our witnesses older Americans have special
needs that make them particularly vulnerable during an emergency. Todays hearing will seek to determine what those needs are
and how those who are charged with formulating our nations responses can incorporate best practices so these concerns are specifically addressed.
A key lesson learned in the aftermath of the recent hurricanes
is that government at all levels must do more to ensure the health
and safety of older Americans during a disaster. Many in this population are extremely vulnerable, and it is the governments responsibility to ensure that adequate steps have been taken to identify those in need, evacuate them to safety, and provide appropriate
care once they are displaced.
There is no doubt that this poses a daunting challenge, but as
we will hear from many of todays witnesses, states, localities and
provider groups have instituted outstanding systems that have
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proven effective. I hope the testimony from todays distinguished
witnesses allows this committee to learn about best practices in
disaster preparedness, and enables us to move forward with concrete recommendations for how best to protect our most vulnerable
citizens during emergencies.
As we have learned, once a disaster strikes, it is too late to begin
deciding the appropriate course of action. Rather, we must be prepared well before the crisis is upon us in order to give our responders the best opportunity to identify those most at risk and to get
them to safety.
As we will also hear from our witnesses, no two older persons are
alike. The diversity of need is vast, ranging from those who are
cared for in a nursing home or hospital to an active person living
on their own and still able to drive. However, when a disaster
strikes, we are all vulnerable, and extra care must be taken to ensure that older persons are able to get out of harms way.
As members of this committee, I believe we are protectors of
older Americans, charged with ensuring that our government is
taking appropriate care of those in need. Therefore, as we contemplate policies to improve our countrys disaster preparedness,
we must consider the special needs of this older population; namely, how do we identify people who have health or mobility challenges who cannot evacuate on their own; how do we safely transport people with various levels of healthcare needs out of an impacted area; how do we identify or create special-need shelters; how
do we ensure emergency medications are available and accessible;
how do we provide meals for people with special dietary needs; how
do we provide personal care aids for those who are unable to care
for themselves; and finally, how do we assess the long-term needs
of older persons and provide assistance in making arrangements
for appropriate care?
As we listen to the testimony of our witnesses today, we will
hear details about the considerable work they have done in their
communities to address these important concerns. All provide some
excellent examples of positive results that can be achieved with
thorough planning and early preparedness. Large scale natural disasters like the hurricanes that struck the Gulf Coast stretch our
federal, state and local response capabilities to their absolute limits
and we must be prepared.
I am hopeful todays witnesses will give our committee members
valuable insight on the special needs of older Americans to help us
ensure that no lives are needlessly lost during future emergencies.
Again, I thank you all for coming and sharing your expertise with
us.
Now, let me turn to my colleagues, Senator Dole and Senator
Martinez.

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3
OPENING STATEMENT OF SENATOR ELIZABETH DOLE

Senator DOLE. Thank you, Mr. Chairman, for calling this hearing
today on such timely and critical issues. As a former president of
the American Red Cross and as a senator from North Carolina, obviously, I have witnessed firsthand how easily hurricanes and other
disasters can strip away property and possessions, threaten lives,
and leave folks displaced.
As everyone in this room knows all too well from the events of
recent weeks, disasters can be especially devastating for our elderly
citizens. Many factors make our seniors more vulnerable in their
daily liveslack of mobility, chronic medical conditions that require daily medications and other treatments, isolation from family
and friends, and limited financial resourcesand it is the very
vulnerabilities that put the elderly at extraordinary risk when disaster strikes. We must be ever mindful of the limitations that put
our seniors at higher risk in a disaster, and prepare and plan accordingly.
Public and private partnerships at all levels of government are
vital to reducing disaster suffering and damage. No single organization has the time, the people, or the financial resources to do all
that needs to be done. Government agencies and organizations like
the American Red Cross emphasize the importance of personal responsibility, urging businesses, schools and families to have an
emergency plan in place.
Seniors, and the ones who care for them, also must be strongly
encouraged to have such a plan. Like everyone else, they readily
need emergency phone numbers, blankets, cash and a first-aid kit,
but many seniors also need oxygen, prescription drugs, and extra
batteries for hearing aids and wheelchairs. We need to encourage
personal preparation for our seniors, as this would greatly minimize their stress and trauma in a disaster situation.
Of course, communication and information access are critical in
a disaster, not just to facilitate response and recovery efforts, but
also to assist the victims. That is one of the reasons that I am a
strong supporter of 211, an easy to remember phone number that
those who need assistance or want to volunteer can use to connect
with community services and volunteer opportunities. 211 is currently available in 22 states, and I have co-sponsored legislation
that would expand this service nationally.
When someone calls 211, trained staff and volunteers analyze
what services are needed from nonprofits, government agencies,
and other organizations, and then they quickly connect the caller
with those services. In the Gulf Coast, 211 has served as a valuable
resource for people devastated by Katrina and Rita. For example,
in Louisiana, an elderly caller desperately needed his medication.
He did not have a doctors prescription, but he did have empty
medicine bottles. The 211 call specialist got in touch with his local
pharmacy and verified that it would supply his medicine. The call
specialist then quickly called the man back and gave him the information he needed to get his medication.
Like the elderly man in Louisiana who needed that medication,
many of our older Americans have special needs that must be addressed before, during and after a disaster. This committee has a
unique responsibility to carefully consider these issues, and I ap-

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4
preciate the presence of each and every witness here today, and I
want to thank each of you for all that you do to protect our older
Americans when disasters strike.
Thank you, Mr. Chairman.
The CHAIRMAN. Thank you, Senator Dole.
Senator Martinez.
OPENING STATEMENT OF SENATOR MEL MARTINEZ

Senator MARTINEZ. Mr. Chairman, thank you very much, and

thank you for holding this important hearing today. It is important
that we focus on the unique needs of the elderly in times of natural
disasters. As Congress continues to exercise proper oversight in examining the response by government at all levelslocal, state and
federalto the damage caused by Hurricane Katrina and what the
appropriate federal role in responding to natural disasters should
be, I want to call to your attention a piece written by Florida Governor Jeb Bush, which published in The Washington Post on September the 20, of this year. I would like to, with your concurrence,
make it a part of the record of todays hearing.
The CHAIRMAN. We will include it in the record.
[The information follows:]
In the wake of Hurricane Katrina, Americans are looking to their leaders for
answers to the tragedy and reassurances that the mistakes made in the response
will not be repeated in their own communities. Congressional hearings on the successes and failures of the relief effort are underway.
As the governor of a state that has been hit by seven hurricanes and two tropical
storms in the past 13 months, I can say with certainty that federalizing emergency
response to catastrophic events would be a disaster as bad as Hurricane Katrina.
Just as all politics are local, so are all disasters. The most effective response is
one that starts at the local level and grows with the support of surrounding communities, the state and then the federal government. The bottom-up approach yields
the best and quickest resultssaving lives, protecting property and getting life back
to normal as soon as possible. Furthermore, when local and state governments understand and follow emergency plans appropriately, less taxpayer money is needed
from the federal government for relief.
Floridas emergency response system, under the direction of Craig Fugate, is second to none. Our team is made up of numerous bodies at all levels of government,
including state agencies, the Florida National Guard, first responders, volunteer organizations, private-sector health care organizations, public health agencies and
utility companies. Once a storm is forecast for landfall in Florida, all these groups
put their disaster response-and-recovery plans into high gear.
Natural disasters are chaotic situations even when a solid response plan is in
place. But with proper preparation and planning, it is possibleas we in Florida
have provedto restore order, quickly alleviate the suffering of those affected and
get on the road to recovery.
The current system plays to the strengths of each level of government. The federal
government cannot replicate or replace the sense of purpose and urgency that unites
Floridians working to help their families, friends and neighbors in the aftermath of
a disaster. If the federal government removes control of preparation, relief and recovery from cities and states, those cities and states will lose the interest, innovation and zeal for emergency response that has made Floridas response system better than it was 10 years ago. Todays system is the reason Florida has responded
successfully to hurricanes affecting our state and is able to help neighboring states.
But for this federalist system to work, all must understand, accept and be willing
to fulfill their responsibilities. The federal government and the Federal Emergency
Management Agency are valuable partners in this coordinated effort. FEMAs role
is to provide federal resources and develop expertise on such issues as organizing
mass temporary housing. FEMA should not be responsible for manpower or a first
responsefederal efforts should serve as a supplement to local and state efforts.
Florida learned many lessons from Hurricane Andrew in 1992, and we have continued to improve our response system after each storm. One of the biggest lessons
in that local and state governments that fail to prepare are preparing to fail. In

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5
Florida, we plan for the worst, hope for the best and expect the unexpected. We understand that critical response components are best administered at the local and
state levels.
Our year-round planning anticipates Floridas needs and challengeswell before
a storm makes landfall. To encourage our residents to prepare for hurricane season
this year, for 12 days Florida suspended the state sales tax on disaster supplies,
such as flashlights, batteries and generators. Shelters that provide medical care for
the sick and elderly take reservations long before a storm starts brewing. To ensure
that people get out of harms way in a safe and orderly manner, counties coordinate
with each other and issue evacuation orders in phases. Satellite positioning systems,
advanced computer software and a uniform statewide radio system allow all of these
groups and first responders to communicate when the phones, cell towers and electricity go out.
The Florida National Guard is deployed early with clear tasks to restore order,
maintain security and assist communities in establishing their humanitarian relief
efforts. Trucks carrying ice, water and food stand ready to roll into the affected communities once the skies clear and the winds die down. Counties predetermine locations, called points of distribution, that are designed for maximum use in distributing these supplies.
Floridas response to Hurricane Katrina is a great example of how the system
works. Within hours of Katrinas landfall, Florida began deploying more than 3,700
first responders to Mississippi and Louisiana. Hundreds of Florida National Guardsman, law enforcement officers, medical professionals and emergency managers remain on the ground in affected areas. Along with essential equipment and communication tools, Florida has advanced over $100 million in the efforts, including more
than 5.5 million gallons of water, 4 million pounds of ice and 934,000 cases of food
to help affected residents.
I am proud of the way Florida has responded to hurricanes during the past year.
Before Congress considers a larger, direct federal role, it needs to hold communities
and states accountable for properly preparing for the inevitable storms to come.

Senator MARTINEZ. He illustrates the way that local and state

governments most effectively prepare for a crisis and the proper
role of the federal government. A senator from that state, Florida,
which has experienced seven hurricanes and two tropical storms in
the last 13 months. I urge the consideration of the successes and
the challenges that Florida faces very uniquely when disasters
occur.
Mr. Chairman, I can remember last year in the aftermath of
Hurricane Charley, which was the first one to ravage Florida last
year, a group of elderly citizens who had been transported from the
Port Charlotte area to Tampa. The building where they lived had
been completely destroyed. They had been relocated to a hotel and
it appeared they were going to live there for several months.
The thing that struck me the most about that was the spirit of
these people. They were all displaced, all in need of their medication, their routine, their doctors, the things that become a part of
the daily life of elderly American, and yet their spirit was incredible. They were determined to get on with life, grateful for every
little thing that was done for them, and understanding that they
were going to be displaced for a period of time, but determined not
to let this completely alter and change their lives. I think that incredible spirit is what we need to try to encourage while providing
the necessary and vital services.
When I was in local government I know how hard we worked to
provide the special-need shelters that Senator Dole was discussing,
and would have them available to all of the special needs population that may be medically dependent, but particularly our elderly population and the special needs that they would have.
The thing that I find that is so in need is for us to look at the
long-term recovery from storms. I think in spite of the Katrina ex-

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perience, that we do reasonably well in the short term. I think we
have to analyze and examine how we improve all that we do. I am
not just suggesting federal governmental intervention, but I am
talking about all levels of community, whether it be the not-forprofits like the Red Cross, or whether it be the involvement of the
faith community, or local and state government, all of that working
together to see how we impact the long-term recovery.
When we look at this vulnerable population, I think one of the
most difficult things is the issues that linger beyond the immediate
aftermath of a storm when one with advanced age, already in medical need, faces long-term displacement from a home or from their
usual surroundings. So I look forward to the hearing and the testimony of your witnesses today and very much thank you for calling
this hearing. Thank you.
The CHAIRMAN. Thank you, Senator Martinez.
To the points that each of you have made, this will be the first
hearing of a number that we will hold, continuing to focus on different aspects that we may yet hear, even today, about how the
governmental response at all levels can be tightened up and improved.
We will now turn to our first witness, our first panel. That consists of Mr. Keith Bea. He is a specialist in American National
Government at the Congressional Research Service. He is here to
discuss the framework that governs how government entities work
together to plan for a respond to disasters.
Thank you, Keith for coming here today.
STATEMENT OF KEITH BEA, SPECIALIST, AMERICAN NATIONAL GOVERNMENT, GOVERNMENT AND FINANCE DIVISION, CONGRESSIONAL RESEARCH SERVICE, WASHINGTON,
DC

Mr. BEA. Good morning, Chairman Smith, Senators Dole and

Martinez. It is a pleasure to be here. On behalf of the director of
CRS, I thank you for the invitation to participate in this important
hearing. As you know, all CRS analysts who testify before a
congressional committee are prohibited from making policy recommendations, and must confine their remarks to their field of expertise.
Pursuant to the committees letter requesting my participation
today I will provide information in three areas. First, overview of
federal emergency management policies; second, a reference to federal evacuation policies; and third, a summary of the interactions
of the federal government with non-federal entities in implementing emergency management policies.
My responsibilities in CRS do not include coverage of the evacuation policies pertinent to care facilities, health institutions, or the
elderly in communities. My colleagues in CRS, some of whom have
already provided material to the committee, are prepared to continue to assist you on these in-depth policy matters as your inquiry
proceeds.
My first task is to provide a brief overview of federal policies.
The Department of Homeland Security administers many, but not
all, of the federal emergency management policies. The Homeland
Security Act of 2002, which established the Department of Home-

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land Security, consolidated many of the functions and missions of
the component legacy agencies.
As shown in Table 1, attached to my testimony, 13 departments,
other than DHS, 8 agencies, the executive office of the President,
and the House of Representatives implement statutory authorities
that touch upon some element of federal emergency management.
Many of these authorities focus on specific types of emergencies or
conditions.
My comments this morning will center on the most significant
policies that relate to the functions of the Department of Homeland
Security, particularly the Emergency Preparedness and Response
Directorate, also known as the Federal Emergency Management
Agency, or FEMA.
Two principal statutory authorities appear pertinent to the committees request for a general overview. These are the Homeland
Security Act and the Robert T. Stafford Disaster Relief and Emergency Assistance Act, often referred to as the Stafford Act.
First, the Homeland Security Act of 2002 vests in the Department of Homeland Security a seven-part mission, which includes
preventing terrorist attacks; serving as a focal point regarding natural and man-made crisis in emergency planning; and other functions as set out in my written statement.
Title V of the Homeland Security Act established the Emergency
Preparedness and Response Directorate within the department; set
forth the responsibilities for the undersecretary for emergency preparedness and response; and for the first time, elucidated the mission of FEMA in a single statutory provision.
The responsibilities of the Undersecretary of Emergency Preparedness and Response, who has also been referred to as the director of FEMA, include managing the response to attacks and
major disasters by positioning emergency equipment and supplies
and evacuating potential victims; aiding recovery from attacks and
disasters; and consolidating federal emergency management response plans into a single, coordinated National Response Plan,
among other functions. I will provide information on the National
Response Plan later in my statement.
Title V of the Homeland Security Act assigns two large categories of responsibilities to FEMA. First, the agency is to implement the Stafford Act and, second, protect the nation from all hazards by leading and support the nation in a comprehensive, riskbased emergency management program.
The second principal federal statutory authority that I will refer
to you is the Stafford Act, which authorizes the President to issue
declarations that direct federal agencies to provide assistance to
states overwhelmed by disasters. Through executive orders, the
President has delegated to the Secretary of Homeland Security responsibility for administering provisions of the Stafford Act. Assistance authorized by the statute is provided through funds appropriated by Congress to the Disaster Relief Fund. A history of funds
appropriated to the Disaster Relief Fund since 1974 is presented in
Table 2 of my written statement.
Under Stafford Act authority, the President or his designees may
take specified actions as summarized in my written statement. The
President may direct, at the request of a governor, that Depart-

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ment of Defense resources be committed to perform emergency
work to preserve life and property in the immediate aftermath of
an incident that may eventually result in the declaration of a major
disaster or emergency.
Also, the Secretary of Homeland Security may preposition supplies and employees. The Act also authorizes the President to issue
a major disaster declaration or an emergency declaration at the request of a government. Major disaster declarations may be issued
after a natural catastrophe or, regardless of cause, after a fire,
flood or explosion. The President may exercise broader authority
when issuing an emergency declaration, generally but not always,
at the governors request. Information on the different types of assistance authorized to be provided after a major disaster or emergency declaration is summarized in my written statement.
A number of administrative policy documents and guidances
have been issued to implement these and other federal statutory
policies. Presidents have issued directives, including executive orders, that set out responsibilities for different aspects of emergency
management.
Following the terrorist attacks of September 11, President Bush
issued Homeland Security Presidential Directives, or HSPDs, that
have established emergency management preparedness and response policies. Section 16 of Homeland Security Presidential Directive-5 required the Secretary of Homeland Security to develop
and administer a National Response Plan. The directive mandates
that the plan integrate federal domestic prevention, preparedness,
response and recovery plans into one all-discipline, all-hazards
plan.
On January 6, 2005, former Secretary Tom Ridge released the
National Response Plan. The National Response Plan includes
emergency support functions assigned to federal agencies and to
the American Red Cross; sets out the interagency organizational
frameworks, and includes annexes for certain types of catastrophes
and activities. Figure 2 of the National Response Plan, also attached to my written statement, identifies the responsibilities of
federal agencies under the NRP for certain missions.
Moving from this overview discussion of statutory authorities,
presidential directives and the NRP, I would like to address a second requested topic, a general discussion of federal evacuation policies that have been enacted by Congress.
A database search of the U.S. Code revealed 15 statutory provisions pertaining to evacuations. Table 3, attached to this testimony, summarizes the provisions and identifies statutory citations.
These statutory provisions range from very general authority to
specific requirements with which agencies must comply. In general,
federal policy acknowledges state authority pertinent to evacuation,
and local officials generally work with state officials to enforce
those laws.
An example I would like to bring to the committees attention is
recent congressional action that occurred after I submitted my
written testimony to the Committee. The conference report, filed on
September 29, that accompanied, the appropriation for the Department of Homeland Securitythats H.R. 2360addresses the issue
of evacuation procedures.

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The conferees recognize that state and local governments must
develop multi-state and multi-jurisdictional evacuation plans and
direct the Department of Homeland Security to develop guidelines
for state and local governments to follow in the development of
those plans. To my knowledge, this legislation awaits the Presidents signature.
Finally, I would like to provide the Committee with insight regarding the complex, intergovernmental and intersectoral relationships involved in federal emergency management.
The National Response Plan, like the Stafford Act, is premised
upon the involvement of non-federal entities. Federal emergency
management involves federal agencies, and as noted by the Senators in your opening comments, state and local governments, tribal organizations, voluntary organizations, the private sector, and
individuals and families. The Stafford Act also requires that federal
assistance be predicated upon the maintenance of insurance and
that federal aid provided under the act not duplicate such assistance.
In addition, the preparedness of families and individuals, the
planning and practices conducted by private organizations, and the
exercise of state and local authorities all converge at the scene of
a significant catastrophe, often, as you know, under the klieg lights
of CNN and other broadcast media. Some sources of information on
activities undertaken by state and nongovernmental entities,
brought to my attention by my colleagues in CRS, are identified in
my written statement.
In summary, the federal role, as established by statute, administrative direction and tradition is bifurcated. One mission is to coordinate the activities of federal and non-federal responding agencies and the other is to provide assistance, whether through financial means, technical aid, or the transfer of material or supplies.
Federal emergency management is based upon policies that concentrate some authority in the Department of Homeland Security
and disperse other authorities to other federal entities. Federal authorities include some provisions on mass evacuation that acknowledge state authority and rely upon a complex mix of governmental
and non-governmental actors.
I appreciate the opportunity to address the committee and stand
ready to respond to questions on the general matter of federal
emergency management policies and practices. Thank you, Mr.
Chairman.
[The prepared statement of Mr. Bea follows:]

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35
The CHAIRMAN. Thank you, Mr. Bea. I suppose my overriding
question to you is, is the Stafford Act sufficient? Does it need enhancement, strengthening? I dont want this to be a finger-pointing
session, but did it work? Did it work in Florida last year? Did it
work in Mississippi, Louisiana and Texas? Does the federal component need to be strengthened?
Mr. BEA. Well, Senator, as I pointed out in my opening comments, we are prohibited from making policy recommendations.
They surgically removed that gland when I came to work for CRS.
But I will tell you that questions have been raised about the adequacy of the Stafford Act. The Stafford Act is based upon 1950
authority that has been amended several times over the decades.
It certainly seems pertinent for Congress to look at the implementation of the Stafford Act, and whether the emergency management
needs of the 21st century are met by not only the Stafford Act, but
by other federal emergency authorities I identify in Table 1.
The CHAIRMAN. I think the American people, generally, when
these things occur, they want government to be responsive and efficient, and I do not think they are much focused on whether it is
local, state or federal; they just want the system to work.
Mr. BEA. True.
The CHAIRMAN. Obviously, so do we. One of the points of this
hearing is to find out what more we need to do statutorily,
regulatorily, to make this response more seamless than it was, at
least in one state.
Mr. BEA. It is a rich area for congressional action, Senator
Smith.
The CHAIRMAN. No question about it.
As you have focused on this hearing, in which our focus is to look
at the needs of the elderly, is there a sufficient way to identify
them, their special needs, and their mobility challenges? Do we
have the right kinds of data about them, where they are, and what
their needs are to be responsive? As I listened to your testimony,
obviously, there are lots of lists. The government is good at making
lists, but are they workable, are they duplicative, are they being
utilized properly?
Mr. BEA. The concept of the National Response Plan and, in general, the Stafford Act, is to coordinate federal responses and nonfederal resources. Clearly, there are improvements to be made. I
am not an expert in the data on elderly population. My colleagues
in CRS can better address that. But, Senator, I will comment that,
generally, the federal emergency management policies do not address particular populations, and that may be one area that the
Senate may wish to pursue.
The CHAIRMAN. You mentioned the double counting by ambulance companies and other emergency providers when establishing
contracts with facilities that need evacuation plans. Does this
work? Is there double counting? Is the complexity too great? Have
there been efforts to ensure that if and when a provider double
counts that they have contingency plans in place?
Mr. BEA. Thankfully, my colleague, Sarah Lister, suggested that
I include that in my statement. It is an indication of the complexity
of significant catastrophes; that if you have established an oper-

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ating procedure, under a normal circumstance, something should
happen; police should be there.
Clearly, what we have seen in the Gulf states is that what happens is the first responders are so devastated and the people you
are counting on to respond are so devastated that they cannot respond. What happens next? What is plan B? Therefore, the double
counting issue, apparently, according to my colleague, is an issue
that has been identified and is just one example of specific issues
that add to the complexity of the mix, that require attention to
some of the details, and also the flexibility to develop responses
with plans B, C and D if necessary.
The CHAIRMAN. Obviously, we care about the safety of first responders. As you have evaluated this system, first responders, do
they have a place to be protected in the event of a hurricane, and
what happens if they run away?
Mr. BEA. The first responders, as often is pointed out to me, are
the people at the scene. If a bomb were to explode in a federal
building, the staff, the Members, the people who are there in addition to the capitol police, would be the first responders. The backup
systems that you have, whether they are federal or non-federal, are
key in ensuring an adequate response if our initial first responders
are not available, whether they departed or whether they were impaired. That is part of the system of planning that should take
place largely through state planning, and the federal guidances are
there to set the framework for state plans.
The CHAIRMAN. I think it would be important also to say, as
much as we want government to get it rightI am reminded of my
wise, old mom that used to say, The Lord helps those who help
themselves. Obviously, personal preparation is very important. I
think we live in a day and age where at both the government and
the individual level, we have to assume the worst and plan for it.
All Americans ought to look to their own security and safety in the
event of catastrophe and engage in provident living because that
will lead to better preparation for the unexpected, which these days
seems to be more expected than ever.
Senator Martinez, do you have questions?
Senator MARTINEZ. I was only going to just inquire as to the
Stafford Act, whether you thought in the recent events there were
clear flaws in it that you could make a recommendation that they
should be amended or changed. Are you prohibited from doing
that?
Mr. BEA. I am, Senator.
Senator MARTINEZ. I guess that is why I did not hear that from
you.
Mr. BEA. I will also tell you I am very respectful of people who
are on the ground there. I have been up here. I watched the news
media; I spoke with people involved. I would be very hesitant to assert my position as a third party evaluator, at this point, in examining what happened down there. Clearly, it was a tragedy; clearly,
mistakes were made.
Senator MARTINEZ. Yes, it does seem to me that it ought to be
reviewed with eyes towards modernizing it and maybe making it
more compatible with todays real situations and the real world.
Mr. BEA. Absolutely.

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Senator MARTINEZ. Sometimes it does take a cataclysmic event
like we had happen to awaken to us the need for reform.
I do go back to the Florida experience where Governor Bush has
very clearly come on the side of maintaining the preeminence of
local government as it relates to evacuations, responsibilities, and
things like that. I am not so sure that there should be anything
done to change that. I think at the end of the day, the federal governments role has always been a secondary role, a role of assistance, prepositioning supplies and things that would come in, in the
second wave. But my own experience in local government is that
those difficult decisions of when to evacuate, and preparing shelters for evacuation that are adequate, and taking into account the
special needs population really squarely falls under the responsibility of state and local government. I am not sure that anything
federally we can do ought to change that.
Mr. BEA. I understand. Absolutely.
Senator MARTINEZ. Thank you.
The CHAIRMAN. Mr. Bea, thank you very much. You have been
a great witness, and you have added measurably to the record and
given us some things to work on.
Mr. BEA. Thank you, Senator.
The CHAIRMAN. Our second panel consists of Ms. Maria Greene,
who is the director of the Division of Aging Services in the Georgia
Department of Human Resources. Ms. Greene will discuss how her
agency works with the Georgia Emergency Management Agency to
ensure the safety of older Georgians during a disaster.
Also on this second panel is Dr. Jeffrey Goldhagen. He is the director of the Duval County Health Department, which is home to
Jacksonville, FL. He will be giving us an overview of the system
his health department has instituted to assist the elderly and other
special needs individuals in preparing for and evacuating during a
disaster.
Ms. Greene, thank you for being here.
STATEMENT OF MARIA GREENE, DIRECTOR, DIVISION OF
AGING SERVICES, GEORGIA DEPARTMENT OF HUMAN RESOURCES, ATLANTA, GA

Ms. GREENE. Good morning, Chairman Smith and distinguished

members of the committee. I am the director of the Division of
Aging Services, designated as the state unit on aging. It is my
pleasure to talk with you today about Georgias emergency preparedness plan as it relates to older adults and people with disabilities.
The organization of the Department of Human Resources is
unique in its ability to respond to the needs of citizens. We have
integrated and coordinated plans that have been tested and improved upon. Georgia responded quickly and resourcefully in assisting people fleeing from hurricane-ravaged states, and we have new
lessons learned to incorporate into our planning.
Along with Aging Services, the department is an integrated
human services agency that includes divisions of Public Health, the
Mental Health State Authority, and Family and Children Services,
just to name a few. The coordinated efforts of the department,

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other state agencies, local governments and private-sector organizations comprise our states emergency plans.
In conjunction with the department, the area agencies on aging
have county, city, regional and state emergency preparedness
plans. The plans include the coordination of first-responder tasks
with the local EMS, law enforcement, and county officials. The area
agency on aging staff identifies at-risk older adults and people with
disabilities that receive services through our network. These individuals would need assistance to evacuate in an emergency and
have no immediate family caregiver to aid them. Citizens who do
not receive public benefits but are in need of assistance, before or
after a crisis, are encouraged to register with the local EMS or a
law enforcement agency.
Our protocol was put to test during an after-hours chemical accident at a laboratory in the metropolitan area. Citizens in the vicinity needed to evacuate. The local aging service provider had a special needs list of people who receive our services and are in need
of assistance during an emergency. The client listing is updated
quarterly and shared with local EMS and law enforcement. The
care managers had a copy of the client list in their homes, and
were ready to help when the staff telephone tree was activated. Everyone was assisted to safety, but one lesson learnedjust a small
lessonfrom that experience was the need for automobile cell
phone charges due to the batteries running down and having no
immediate access to the buildings.
Most recently, Georgia was able to assist individuals displaced
from the states impacted by the hurricanes. Governor Purdue,
Commissioner Walker, and I were at Dobbins Air Force Base when
people were air lifted from the Gulf states. Many of the people were
elderly and disabled.
During the chaos of a disaster of this magnitude, it is understandable that many people arrived and were quickly placed in
shelters, hospitals, and facilities. It was not immediately known,
however, where all the individuals were placed. The Long-Term
Care Ombudsman Program, the Office of Regulatory Services, the
Georgia Advocacy Office, the community service boards, and all of
the area agencies on aging have worked tirelessly to identify the
displaced individuals placed in facilities. These individuals have
been reunited with families, moved to more appropriate home and
community services, and assisted in the facilities where they
choose to remain.
Many fine examples of emergency response developed from our
work. Nursing home and personal care home associations and mental health hospitals monitored their bed vacancies. Senior centers
generously volunteered to be used as rest areas and lunch locations
for persons regardless of age. The state created resource centers,
where one-stop access for services could occur. Georgia embraced
flexibility for benefits and developed assessment teams to go to hotels, where large numbers of displaced persons were staying. The
team members were comprised of staff throughout the department,
including aging and the disability networks.
During a crisis, we all feel that the bulk of our work is happening at that point in time. What we are actually learning is that

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assistance after the crisis, especially by human service organizations, is crucial.
During the time of crisis, so many people are at their best, but
others are at their worst behavior. Unscrupulous people will use
disaster to put money into their own pockets, money that was intended for those who were suffering. The Adult Protective Services
Program and elder abuse prevention specialists were called upon to
investigate and intervene on cases of suspected abuse, fraud and
exploitation of the hurricane victims. In the future, our revised
emergency preparedness plan will include additional planning to
prevent the abuse before it starts.
Also as a result of consumer fraud and exploitation, the increased need for elderly legal assistance has become very apparent.
A special training to lawyers around specific legal interventions for
displaced persons is occurring this month.
Another valuable lesson learned is the significant needs of people
who have cognitive impairments. Mental health professionals were
available to offer mental health crisis support, but the knowledge
of someones dementia or Alzheimers was unknown. Electronic
medical records and access to basic healthcare information would
have aided appropriate placements for a special needs shelter.
Our department is an exceptional, integral part of Georgias
emergency response before, during and after a crisis. Communications, coordination and understanding of older adults and people
with disabilities are critical to disaster preparedness. Work to modify our existing emergency plans to incorporate these lessons
learned is currently underway.
Thank you for the opportunity to share with the committee Georgias experience in emergency preparedness.
[The prepared statement of Ms. Greene follows:]

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45
The CHAIRMAN. Thank you very much.
Ms. GREENE. You are welcome.
The CHAIRMAN. Jeffrey Goldhagen. Thank you.
STATEMENT OF JEFFREY GOLDHAGEN, DIRECTOR, DUVAL
COUNTY HEALTH DEPARTMENT; AND ASSOCIATE PROFESSOR OF PEDIATRICS, UNIVERSITY OF FLORIDA, JACKSONVILLE, FL

Mr. GOLDHAGEN. Well, thank you, sir. It is a pleasure to be here,

Chairman Smith. Certainly my distinguished Senator from Florida,
it is a great opportunity to be here. My bias is going to come out
pretty squarely, pretty quickly as I move through this presentation.
The nation has 3,000 local health departments. Now, all those
local health departments are at various levels of sophistication
with respect to their ability to respond and their capacity to respond, but, fundamentally, the responsibility for that first response
and for the health and well-being of special needs citizens, including the elderly, fall fairly straight-forwardly on the shoulders of
local health departments.
The CHAIRMAN. Should it be otherwise?
Mr. GOLDHAGEN. No, it should not be otherwise. We are central
partners with the public safety colleagues, but, in fact, it is pretty
straightforward what the responsibilities of our public safety agencies are. It is pretty well-defined and they are fairly well-funded.
But, in fact, for public health, that definition is not quite as welldefined nationally, and we have not had the degree of funding that
our public safety colleagues have had.
With respect to special needsjust a broad overviewwe are responsible for identification of all special needs people, citizens in
the community and their triage. We are responsible for ensuring
their transportation to appropriate shelters. We are responsible for
ensuring that, in fact, their medical needs are met, their mental
health needs are met, their social service needs are met within the
context of the shelters. We are responsible for post-event planning
to make sure that they are discharged and get to a venue that is
safe for them, ensuring, in fact, they get to those venues.
In particularand I think it relates to the question about double
countingwe are responsible for ensuring that the system works.
There are hospitals in this system, there are home health agencies
in this system, there are ambulance companies in this system,
there are dialysis centers in this system. There are numeral parts
of this system that have to work. In fact, it is local health departments that are responsible that the system responds appropriately,
and to be accountable and to intervene when, in fact, those systems
are not, both prospectively as well as during the event.
It is critical to understand the important role that we play because over the last several decades, in fact, the infrastructure of
public health has been allowed to deteriorate. It may be too strong
a word to say that it has decimated, but it has been allowed to deteriorate. The Institute of Medicine has put together two very
poignant reports on that, and, in fact, what we see now is that if
that infrastructure is not available and present, then we are not
able to respond.

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Let me go into some more specifics, some of the challenges. We
have to make sure that, in fact, the shelter is open. We have to
make sure that there is medical personnel. We have to make sure
that there is access to medication, access to oxygen, availability of
dialysis. That is our responsibility. We are also responsible to make
sure the hospitals are prepared. In fact, it is our responsibility to
make sure they have generators in place, that assisted-living facilities have generators in place, that, in fact, the shelters have generators in place, so that is essentially our responsibility.
It is our responsibility to make sure that, in fact, the equipment
that is required in the shelters are there, whether it is lifts to
make sure that we can lift overweight people or appropriate cots
that fill the needs of those that are elderly, and on and on.
Now, with respect to what we have been able to do in Duval
County, we are very proud of what we have been able to put together. With respect to what Senator Martinez had said a moment
ago, that, in fact, is the secret to our success, that local communities have assumed responsibility and particular local public
health agencies have assumed responsibilities.
In Jacksonville, as an example, at least once a year, sometimes
twice a year, we put out a request for registration for special-needs
in the utility bills. So we get information through the utility bills
as well as a number of other sources of information to identify and
register all of the people with special needs.
All of that information goes into a searchable database. That includes extensive information, and I am going to read some of that
information; demographics on the individual; who the persons physician is; what pharmacy they use; what medications they have;
what home health agency they use; who are their emergency contact persons in and out of town; permission to search their home
after an event; again, their medications; what disabilities they
have, what special medical needs they have or transportation requirements they have; whether they live in a surge zone; and so
on. That is all searchable, based on what category storm is coming
in and the type of event that might be happening.
The CHAIRMAN. Jeff, you actually get written permission to enter
their homes ahead of time.
Mr. GOLDHAGEN. Right.
The CHAIRMAN. So that, obviously, is a very significant educational toolpeople understand there is one that can help, and
you know who they are and what their needs are.
Mr. GOLDHAGEN. Right, absolutely.
The CHAIRMAN. Have you had an occasion to test this? Obviously,
you had four hurricanes last year. Was Duval County affected?
Mr. GOLDHAGEN. Yes. We were affected not to the extent that
Southern Florida was affected. Yes, we have detract teams, which
are teams that actually go out post-event to actually look at peoples homes to find out whether or not there is electricity, not electricity, whether it is appropriate to send the person back, and
whether a person in fact registered to come to the shelter actually
came. Sometimes when we arrange the transportation with the
other emergency service function, if people refuse to actually be
transported, we will go back after the event to make sure that, in
fact, they are okay.

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We have a very interesting program called Adopt-A-Shelter program, and each of the hospitals in Jacksonville have adopted a special-needs shelter. They are responsible for assuring that there is
personnel, not only physician nurses, but respiratory therapists.
They are responsible for making sure that all of the material that
is needed in the center is there.
We have a contract with a medical supply company, and that
contract includes maintaining an inventory over time so that if we
need to open up a shelter, we pick up the phone. The medical supply company drops everything that is needed to run that center,
and we then walk in with our personnel and it is all there, from
oxygen to medications, and so on. If we have to change a venue
after the event, they take all of that material and move it to another venue.
We have 500 people in the Medical Reserve Corps who serve as
a background for us to back us up. That includes physicians,
nurses, respiratory therapists, and so on. We have ham operators
in each of our shelters, and the community is completely connected
by an 800 mega hertz radio system.
My time is really, actually over. I just want to focus on several
recommendations. The first is an all-hazards approach. There has
been a tremendous amount of assets and resources that have come
down to the local level. We would say that most of it has not come
to the health departments public account, but there has been a tremendous amount of resources coming in. Unfortunately, it has been
categorical, focused on bioterrorism. We need the ability to use the
resources that come in, in an all-hazards approach so that we can
be as prepared to deal with a hurricane as we are with an anthrax
attack. That would be the first recommendation that I would have.
The second is, frankly, that a focus needs to be put in the public
health infrastructure nationwide. In fact, if we are able to respond,
or the capacity to respond, we can in fact do so. Clearly, what happened in Katrina is once there was a focus off of the public safety
issue, the focus was on public health, and this is a public health
emergency and so on. So, ultimately, all disasters deteriorate essentially into a public health disaster and public health system.
We need to make sure that public health departments understand that, in fact, they are responsible for the systems response
and coordinating the other elements of the health system. We need
state laws that really require local jurisdictions to create these
searchable databases, and make it very well defined. In fact, the
public health system is responsible for these roles and responsibilities.
Finally, let me reiterate again, we need flexibility. We need the
ability to use the assets and resources that are coming from the
federal level to meet the needs of our local communities. If that
happens, then we have the capacity to actually respond to make
sure the systems work.
[The prepared statement of Mr. Goldhagen follows:]

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59
The CHAIRMAN. Well, Mr. Goldhagen and Ms. Greene, you both
are truly to be congratulated for the work you have done in your
communities and counties to prepare, particularly for the focus on
the seniors, and mental health issues, and special services for people with dementia. It is actually a very remarkable kind of plan
you have in place. I guess my question to you is, in your dealings
and in your associations with other states and counties, do most
have the level of preparation that you have in these Gulf state
areas?
Mr. GOLDHAGEN. Well, I would say most definitively in the state
of Florida. The reason for that is, quite frankly, a history of how
Floridas public health system has been established. That is there
are 67 counties. There are around 65 local health departments. The
expectation from the state and expectation of the counties are that,
in fact, the health departments and the local systems are going to
respond. So, then, in the context of a system that is structured like
that, the answer is yes. On the other hand, using another state,
which I came from, which was Ohio, in Cuyahoga County, as an
example, there was the county health department, there was the
City of Clevelands health department, and there were multiple
other local health departments.
So part of the answer, recommendations, need to make sure that
counties have a coordinated system at the local level that are going
to work, and that the agencies responsible have the capacity and
the resources to, in fact, do so. I sat in awe and listened to Mr. Bea
talk about the structure at the federal level. But ultimately, if it
is going to work, the real focus needs to be at ensuring the capacity
at the local to respond.
The CHAIRMAN. Florida had four tough hurricanes last year, but
the response wasI heard Senator Martinez even speak to it
Mr. GOLDHAGEN. Remarkable.
The CHAIRMAN [continuing]. Pretty darn good at the local, state
and federal level. I think you even commented that FEMA really
showed up and got it done. I think that that is a real credit to Florida and to FEMA, and the people who were all concerned.
Ms. Greene, are you familiar with S. 1716 that has to do with
100 percent Medicaid reimbursement for states like yours who are
taking in refugees? Are you aware of it, and is that important?
Ms. GREENE. Yes, sir. Oh, it is. My understanding is that Georgias 1115 Medicaid waiver request has been approved, and it was
modeled similar to Texas. I believe Georgia according to FEMA had
40,000 plus heads of households registered from the Gulf states
that had come to Georgia. My understanding is we will have a fivemonth, 100 percent federal matching rate for those people. Many
of them have come either into our nursing homes and maybe never
needed a nursing home, and now we are moving them into the
Medicaid waiver for home and community-based services, the community care services program that we manage. We are very appreciative at that immediate assistance, and it is going to help us out
a lot.
The CHAIRMAN. Well, we are going to get it done. I think it is
also fair to say, in relationship to Louisiana, that even the best
plans can be overwhelmed by natural disasters. Would you agree
with that?

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Ms. GREENE. I would agree. The advantage, at least for us, is
that since we were not a disaster statewe actually had electricity,
utilities, cell phone towersit is much easier to help the displaced
individuals. I can imagine lessons learned from the Gulf states is
going to be 10-fold, of the ones that I mentioned today just for
Georgia.
The CHAIRMAN. Mr. Martinez.
Senator MARTINEZ. Thank you, Mr. Chairman.
I will say that Floridas preparedness today, in great measure, is
owed to the failures of Andrew in 1992, when things did not go
quite as well. I think a lot was learned there, and I think a lot of
those lessons were applied, and equally, I think we need to learn
from Katrina, so that we can move forward in a better way.
Dr. Goldhagen, I just want to welcome you. As a fellow Floridian,
I am proud to have you here and proud of the work that you all
do in Jacksonville. I know Mayor Payton is a great local leader and
does a great job as your local leader. You have had a good heritage
of good mayors in the City of Jacksonville, which I know makes a
big part of your ability to do what you do in your department.
I was going to ask you about specifically what areas where you
feel there is need for flexibility, if you could be a little more specific
so that I can maybe be more helpful and more responsive. I am
very sensitive, coming from local government, about assistance that
come from gifts with strings attached to such an extent that it, perhaps, makes it unusable for the needs that you have. Particularly
as it relates to emergency response, we have to make sure that we
take away constrains to the flexibility that local governments will
need as they attempt to deal with emergencies.
Can you be specific with that?
Mr. GOLDHAGEN. Sure. I can give you actually a wonderful example that certainly the disaster in New Orleans identified for us.
Jacksonville, for those of you who do not know, is just an absolutely beautiful city situated on the ocean, but also having a river
that runs through it, the St. Johns River. We have two of our largest hospitals, actually, on the river, Baptist and St. Vincents hospitals. They have their generators on the level of the river, and all
of their electrical equipment and switches, as an example are basically at that level too. So, in fact, in a situation where you want
to evacuate vertically, or move people up as opposed to moving
them out, that would not be possible in this situation.
The HRSA dollars that are coming to Jacksonville do not allow
us to invest putting ancillary, auxiliary generators up high enough
to allow them then to evacuate vertically, which would eliminate
the kind of problems that we saw happening in the hospitals in
New Orleans. That would be one very specific example of how we
would use the federal dollars in a different way if we were allowed
to, in fact, use those dollars in that context.
Now, one might say that it should be the responsibility of the
hospitals. The hospital systems are under significant distress in
some respects. There is not the resources necessarily in the hospitals to actually do that, or with some additional dollars, that we
would be able to do that.
That would be an example of how we would use the dollars that
are coming from the federal government if, in fact, we have flexi-

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bility. Most of the dollars coming through Homeland Security,
through HRSA CDC, come with strings attached to focus very specifically on bioterrorism and terrorism events. In fact, what we
need to do is to be able to use those dollars in an all-hazards approach so that, in fact, we are as prepared to deal with a hurricane
again as we are to deal with whether it is a radiological or biological event.
Senator MARTINEZ. Thank you.
One of the really egregious examples of failures in New Orleans
is the issue of the nursing homes that, perhaps, or obviously, were
not timely evacuated or evacuated at all. How does Duvaland Ill
take it on to Georgia as well, ask both of you to address. How do
you deal with these vulnerable populations that you know are in
situations where they are going to be totally dependent? How do
you deal with them in terms if evacuations are necessary and providing for a better situation if they need to be evacuated?
Ms. GREENE. I think, obviously, the key is communication. We
have heard several times that as much communication that you
can do in advance is beneficial. I know we require, through our Office of Regulatory Services, that they have emergency plans. Those
are checked on to see that they are in place. But if they do not
heed the warnings earlybecause we know that with older people
and people with disabilities, you are going to need a little bit more
time to help them move. Helping them to move, you also have all
of their wheelchairs, their walkers, their medicines, and their
records that would be helpful to go with them. So time is of the
essence in that pre-planning, and that communication is essential.
Mr. GOLDHAGEN. I would agree. But I would like to just comment
on the issue of double counting. I am not exactly sure what that
meant. But, again, I think it really focuses the issue on the capacity of local government to respond.
When we actually evacuated the beaches last year for one of the
hurricanes, it became very clear that the ambulance companies
if this is what you meant by double countinghad multiple contracts, all with different facilities, including the hospital and so on.
What we were able to do was take over the system.
We then stepped inthe health department, the ESFA, took over
the system, took over the ambulance, triaged the ambulance, got
the hospitalwhich we have one at the beachesevacuated early,
and then assured that the system was in place to orderly evacuate
each of the nursing homes that needed to be evacuated.
Without a strong local health system, nobody could have walked
in and taken over the actual function of the ambulance services to
ensure that, in fact, there was a coordinated approach to what
needed to happen. So, again, it comes back to emphasize the critical role, both predictable as well as unpredictable. We had not predicted that, in fact, the local ambulance companies had multiple
contracts with the same people to do the same thing, but because
a system was in place, we assumed that responsibility.
Senator MARTINEZ. In those instances, though, where the beach
was evacuated, how far in advance was that carried out, whose decision was it to evacuate, and who executed the decision to evacuate?

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Mr. GOLDHAGEN. Well, the way the system works, it is the mayors decision. We meet as an executive group, which is probably 30
to 40 people.
Senator MARTINEZ. The EOC?
Mr. GOLDHAGEN. At the Emergency Operation Center, right,
which 12 years ago was one room with three telephones, and today
is an extremely sophisticated, high-tech center. We meet. The
mayor makes the decision. There is a complex set of formulas that
go into exactly how long in advance we should be getting the evacuation. We routinely argue for starting 6 to 12 hours before the
Emergency Operation Center is willing to start, and we go through
that discussion and tension, and a decision is made when to do it.
Then the emergency service functions go into place, and we work
in a coordinated way, with all of us sitting around in the same facility.
Senator MARTINEZ. Those are all functions of the local officials.
Mr. GOLDHAGEN. Yes.
Senator MARTINEZ. My experience in Orange County was that we
pretty much made those decisions and carried them out ourselves.
Mr. GOLDHAGEN. Yes.
Ms. GREENE. It is similar in Georgia and also with the role of
public health, which I value and support. We have provisions in
Georgia statute for public health to also step up to the plate and
take control if it is not working out, similar to how he was describing it. So my hat is off to the first responders. At times, people
have said, should the aging network be the first responder. We are
seeing the bulk of our work now, after the crisis. We did not necessarily need to be there with the first responders. Our work is
more now.
Senator MARTINEZ. It is the long-term recovery and the issues
that come from that.
Ms. GREENE. Absolutely.
Senator MARTINEZ. Thank you both very much.
Mr. GOLDHAGEN. Thank you for the opportunity.
The CHAIRMAN. To the incident Senator Martinez raised, where
healthcare providers and responders literally abandoned hundreds
of elderly people to die, and they died, I wonder if part of your calculation now is to work with those providers on their own plans for
how to take care of their individual and family needs without abandoning the vulnerable population.
Is that a new calculation in preparedness; that you have to know
who your responders are and what their back bone is going to be
in the event of these kinds of catastrophes?
Mr. GOLDHAGEN. Well, that is not an issue for us, primarily because we work extensively with the medical society, as an example.
When we evacuate a hospital, the physician orders go with the patient. We have worked on creating actually bilateral agreements
with nurses so, in fact, with the hospitals, to allow nurses from one
hospital to actually follow with the patients to another hospital,
and have worked through all the legal issues related to that, so
that if one hospital is evacuated, the nursing staff goes at that entity.
Again, in our database system, we have the information as to
who the doctors are, and have worked with the hospitals, as well

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as the medical society, to ensure that, in fact, that is not an issue
for us. When we need the physicians, they are able to evacuate
with their families, so that we care for the families as well as
them, if they are involved with the emergency response.
The CHAIRMAN. That is very good news. Duval County is lucky.
I hope every county prepares in the future the way you have. Of
all the tragedy in this Katrina episode, I think the most disgraceful
was the abandonment of these elderly people to die. I mean, I do
not know how that happens in the 21st century, but it did.
Thank you both for your presence here. It has been wonderful,
the contribution you have made to our hearing today. With that,
we thank you, and we will call up our third and final panel.
The CHAIRMAN. Panel 3 will consist of Ms. Leigh Wade, who is
the executive director of the Area Agency on Aging in Southwest
Florida. She will discuss the role of area agencies on aging during
a disaster. Her experience during past hurricanes have led her to
work more closely with communities in developing disaster preparedness plans.
We will also have Dr. Carolyn S. Wilken. She is an associate professor in family science, and a cooperative extension specialist in
the area of gerontology at the University of Florida. Dr. Wilken is
here today to discuss communication and transportation issues that
older Americans face during these disasters.
Finally, Susan Waltman is the senior vice president and general
counsel at the Greater New York Hospital Association. Ms.
Waltman is here to discuss her role as a healthcare representative
in New York Citys Emergency Operation Center, EOC, during a
disaster, and how she identifies and coordinates responses to
healthcare emergencies.
We thank you all for being here.
I suppose, Susan, maybe there is a slant you can give, not a natural disaster, but on a human cause disaster like 9/11 certainly
presented your city with.
Why dont we start with Ms. Wade.
STATEMENT OF LEIGH E. WADE, EXECUTIVE DIRECTOR, AREA
AGENCY ON AGING OF SOUTHWEST FLORIDA, INC., FORT
MYERS, FL

Ms. WADE. Good morning, Chairman Smith. Thank you for this
opportunity to present today.
My name is Leigh Wade, and I am the executive director of the
Area Agency on Aging for Southwest Florida, Inc., which is based
in Fort Myers, FL. Today, I also speak on behalf of the National
Associations of Area Agencies on Aging, or N4A, which champions
the interest of the nations 650 area agencies on aging, or AAAs,
and 240 Title VI Native American aging programs.
The human suffering caused by Hurricanes Katrina and Rita will
linger in the American consciousness for years to come. Older
adults were particular hard hit by these disasters. We will not soon
forget the images of the frail, older women, 80 and 90 years old,
who were air lifted to safety, or diabetic seniors unable to access
proper medical care in an overwhelmed shelter. Our hearts go out
to our friends on the Gulf Coast. Having lived through many Flor-

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64
ida hurricanes, I have some idea of what they are going through
and what lies ahead.
In 2004, the AAA of Southwest Florida had the misfortune of
bearing the brunt of three separate hurricanes in a little over a
months time when Hurricanes Charley, Frances and Jean hit in
rapid succession. Today, more than a year later, older adults in my
area are still struggling to recover.
Fortunately, we had a disaster plan that we put into action early
on. We called the local older adults to inform them of Charleys approach, and to warn them, they may have to evacuate from their
homes.
During the hurricanes, our agency assessed and responded to the
needs of affected seniors. Working side by side with aging service
providers in the most severely affected communities, we focused on
delivering meals, water and ice to older adults. Our agency staff
helped arrange transportation for the older adults to the special
needs shelters and worked at disaster recovery centers.
We had help from some federal, state and local agencies. Assistant Secretary on Aging, Josefina Carbonell, visited the devastated
areas within three days after the hurricanes hit, and offered the
Administration on Aging funding, assistance, and coordination. On
the other hand, another federal agency did not figure out that we
could help them assist older adults until two months after the first
hurricane hit.
The services we provided exhausted our Older Americans Act
Disaster Funding of $4.3 million. We had to cease accepting applications and have over 100 applications still pending. We are still
receiving calls on a daily basis for more assistance. We found
through our hurricane experiences that older adults have distinct
needs that present challenges to community-wide emergency planning and response. Every stage of an emergency needs to be handled differently when dealing with frail, older adults during evacuation, at the emergency shelters, and when returning to the communities.
There are many challenges in transporting older adults in providing appropriate health services and nutrition; in meeting the
needs of people with special conditions, such as hearing loss and
dementia; in handling emotional issues, which can be complicated
by separation from loved ones and caregivers; and in protecting
people from those people who would prey upon older adults. By definition, disasters and other emergencies reduce any agencys capacity to continue business as usual. However, if properly supported,
area agencies can plan a key role in disaster preparedness.
I can think of at least three major areas where AAAs experiences
and resources could be of service.
First, organizing safe and accessible transportation is critical.
AAAs have a wealth of experience in working with community
transportation authorities and providers through our assisted
transportation programs.
Second, finding appropriate temporary housing for older adults is
another major challenge. In Southwest Florida, many long-term
care facilities were closed permanently or for a long period of time.
AAAs can assist in assessing the needs of older adults for housing
assistance as well as connecting them to other needed services.

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Third, providing continuity of services to older evacuees as they
move from shelters to other temporary housing has also been a significant challenge; one of my own personal pet peeves. Our agency
had difficulty locating older adults who needed gap-filling services
due to regulations that prevented FEMA from disclosing their new
location once they had moved from the shelters to the temporary
housing in FEMA cities. AAAs need to have access to older adults
to ensure that they get the services they need.
To effectively assist older adults during times of crisis, I join
with N4A in offering you the following recommendations, which are
detailed in my written testimony. In order to succeed as a first responder to older adults, AAAs must have better access to decisionmakers; be directly involved in long-range planning; be at the table
in order to coordinate services and have adequate resources, technology and communication tools to respond to older adults needs.
Not only do AAAs need to be at the table when federal, state and
local governments draft their emergency plans, we also need to
take the lead in helping county and city governments adequately
prepare for the aging of the population and the dramatic effect it
will have on our nation. N4A has proposed establishing a new title
in the Older Americans Act that would support AAAs and Title VI
Native American aging programs to do just this. I hope you will
support this new title when the Older Americans Act is up for reauthorization next year.
The CHAIRMAN. Since you asked me to, I will.
Ms. WADE. All right. Thank you very much. I sure do appreciate
it. I am going to count on that.
Thank you for holding todays hearing to call attention to the
special needs of Americas seniors in disaster. I would be happy to
answer any questions you might have.
[The prepared statement of Ms. Wade follows:]

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80
The CHAIRMAN. Thank you, Leigh Wade.
Carolyn Wilken.
STATEMENT OF CAROLYN S. WILKEN, PH.D. M.P.H., ASSOCIATE
PROFESSOR AND COOPERATIVE EXTENSION SPECIALIST,
UNIVERSITY OF FLORIDA, GAINESVILLE, FL

Ms. WILKEN. Good morning, Chairman Smith.

The CHAIRMAN. Good morning.
Ms. WILKEN. Thank you for the opportunity to speak with you.
I have provided detailed written testimony as well as this presentation.
News of the hurricane, flood, wild fire, or other natural disaster
can cause anyone to worry, but such disasters create special challenges for older adults. While some older adults can react quickly
and independently to an emergency, others who are frail, ill, alone,
or institutionalized are at serious risks of injury or death when disaster strikes. In fact, we know that in natural disasters, the elderly
comprise more than 50 percent of all fatalities. We also know that
in times of disaster, older adults respond differently than the general population. Older adults possess a very strong sense of independence and self-reliance accompanied by reluctance to accept
help and a strong, if not overwhelming, attachment to their homes.
A nurse who provided emergency care in Mississippi during Hurricane Katrina said it this way. Seniors are very attached to their
homes. Their possessions, or even the place where their possessions
remain, often take on such a special significance that it is impossible to coax them into evacuation.
This is more than hanging on to things. This is about hanging
on to memories and the accomplishments of their lives. Sometimes
it is the substance of what they have to remind them of who they
were and who they are. But in spite of their hesitancy to leave
their homes, sometimes older adults must evacuate. When that
happens, many must rely on professionals to provide transportation
to safety, yet older adults may be afraid of the transportation process. They worry that they cannot climb on to the bus, or that it will
not stop in time for them to get to the bathroom, or because they
do not know where the bus is taking them or how they will get
back home.
Older Floridians and service providers have had too many opportunities to learn about disasters. If experience is the best teacher,
then Florida has been an attentive student.
Let me describe two successful programs, and there are many
others.
Notice how their successful transportation and evacuation relied
on ongoing communication at all levels. In the Florida Keys, a basic
understanding of the needs of older adultsparticularly their
needs for independence and personal responsibilitypre-planning,
and personal communication were central to the successful evacuation of older adults. In the Keys, older adults were invited to put
their names on a registryand several people have discussed registries todayso that they could be contacted in the event of an
evacuation. When they registered, their physical and transportation needs, among other things, were assessed. This information
allowed emergency planners to prearrange transportation, and ap-

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propriate modes of transportation; buses for the less frail, for example, and a fleet of ambulances from South Florida to transport
those with complex medical needs, such as continuous flow oxygen,
IVs, and critical medications.
As the hurricane formed, older Americans on the registry were
contacted by phone to assess their evacuation plans and transportation needs. A minimum of three follow-up phone calls were made
to assure that each person was given the opportunity to evacuate.
Individuals were told how they would be transportedby a bus or
ambulancewhere they could be taken, and how they would return
to their homes.
In Seminole County, law enforcement officers traveled door to
door to reach people on the sheriffs registry of persons in need of
special assistance. At the same time, senior volunteers from RSVP
make phone calls to reassure older adults and to answer specific
questions concerning transportation and the evacuation process. In
both situations, understanding and respecting the lives and the
concerns of older adults, preplanning for appropriate and sufficient
transportation, and personal communication were central to the
successful evacuation of older adults. Effective disaster response requires consistent communication at the local, state, and most importantly at the individual personal level.
Personal education at a time that is appropriate, and in a method that is appropriate, is the most powerful tool for preparation for
disaster. Cooperative extension service, the outreach arm of the
land grant universities, such as University of Florida, and the Department of Elder Affairs in Florida, communicate with older
adults through written publications such as the EDIS facts sheets,
preparing for disaster after the hurricanes have gone, and the Florida Elder Affairs Publication Disaster Preparedness Guide. Written
materials provide elders with the information they need to make
informed, independent decisions concerning disasters.
Personal communications with older adults requires training.
The fact sheet, Stop, Look and Listen, teaches communication for
one-to-one settings, while another fact sheet, Designing Educational Programs for Older Adults, focuses on communicating with
groups in settings such as disaster recovery centers. I have provided you with copies of these materials.
It is time to develop a national disaster plan that reflects and responds to the specific needs and concerns of older Americans. My
colleagues in Cooperative Extension in the Florida Department of
Elder Affairs would like to respectfully recommend that a coastal
states coalition of professionals and disaster-experienced adults
conduct a best practices conference to prepare the nation to help
older Americans prepare to act quickly in the face of disaster.
The final product of this conference would be an array of written
materials and an interactive, multi-language web site that would
be assessed by disaster planners and older Americans themselves.
The long-term outcome of this conference would hopefully be to reduce the number of deaths and injuries suffered by older Americans during disaster.
Thank you for the opportunity to testify at this hearing. I would
be more than happy to answer your questions today or to follow up

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with additional information at the completion of todays proceedings.

[The prepared statement of Ms. Wilken follows:]

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93
The CHAIRMAN. Thank you both very much. Before we go to
Susan, I wanted to ask you a question.
Were you living in Florida when Hurricane Andrew hit?
Ms. WILKEN. I was not.
Ms. WADE. I was.
The CHAIRMAN. The poor response to Andrew, did that precipitate all the planning and preparation that has gone on since, as
you have seen it?
Ms. WADE. We have certainly seen an increase in the requirements for the construction industry, and we feel that there were a
lot of lessons that were learned we were able to apply to the hurricane season of 2004. But even with Hurricane Andrew, being able
to respond to four separate hurricanes in one season, I do not think
Hurricane Andrew adequately prepared the state for that, but certainly there were a lot of lessons we were able to apply, but we
have learned a lot more since then.
The CHAIRMAN. Is there any evidence of the constructions standards being enhanced? Did they work in the subsequent storms?
Ms. WADE. We have seen the houses that were able to withstand
the wind. Its really interesting. If you go through the different
communities that were affected, some of the houses withstood the
winds. The same construction company built another house right
next-door to it which could have been destroyed. But we really do
believe that those standards did help the construction industry.
But when we look at some of the mobile home units, I do not
know that they are currently at the level that they need to be, or
people that live there need to understand that maybe they can only
sustain winds of whatever that maximum is, and then take that
into consideration and worry about your own safety when those
winds exceed that maximum amount.
The CHAIRMAN. Are there consumer disclosures to buyers of such
homes?
Ms. WADE. Yes. They do receive disclosures that tell them what
the sustained winds are.
The CHAIRMAN. Carolyn, you mentioned how hard it is to sometimes coax a senior emotionally away from the world they live in
and the possessions that remind them of an earlier day. When you
provide all the informationthis is where we will take you, this is
what will be available to you, and this is when we will return
youdoes the participation in evacuation go substantially up?
Ms. WILKEN. It does help. There is a lot of fear of the unknown;
where am I going to be, how will my family find me? So giving people information helps them make decisions. When people are
stressed in the time of disaster, often times it is hard to hear what
will happen, particularly for elderly people. It is hard to hear and
to comprehend what is going to happen and how this is going to
happen. So if you get that information very quickly, it makes it
more frightening to go than to stay. On the other hand, if you can
get that information to people in advance, and through the personal communicationsfor example, the RSVP phone calls that
come in Seminole Countythen people have a chance to process
what is going to happen, and that helps them be more willing to
go. It does not replace the possibility of losing my family pictures,

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which is important to everyone. But for older adults, those family
pictures were often of people who are now gone, deceased.
The CHAIRMAN. In the event that all the information, all the
planning, and all the encouraging does not work and they decide
to ride it out, what is done then as a follow up to find out if they
are okay afterwards?
Ms. WILKEN. I think I would have to defer on that question probably to my colleague here. But before I do that, there is something
that I put in my regular testimony, the longer version, which is the
whole ethical decision-making process of mandatory evacuation,
which is something that affects older adults that I think we need
to look at as well.
I would like to defer to you, Leigh.
The CHAIRMAN. Leigh, what is done after the storm?
Ms. WADE. Well, what I can address as far as that is concerned,
taking into consideration that the Department of Health does arrange for the transportation of many of the adults that have registered through the notice that comes out in the electric bill, our
agencies were able to register clients based on our day-to-day interaction with them and to help them understand the necessity of getting registered and being prepared to leave to go to the shelters.
I can remember this lady who lived in a rural county out in
Hendry County, who shared with us that she was not leaving her
house and literally threatened our staff with a shotgun if we came
back. So we left her to ride out the storm. But as soon as the storm
was able, knowing that these clients did stay behind, our staff was
able to get right back out there and make sure they were able to
survive the storm, and then be able to start addressing any needs
that they may have, based on the structure that they were staying
in.
I just want to address your point about the shelters. What we
found was that even after we were able to encourage those people
to go to a shelter the first time, they were exposedyou take into
consideration, this is an older adult who has no children around,
no grandchildren. They have access to them, but they are not living
with them. You put them in a shelter where they are stationed for
days on in, weeks on in, and they are exposed to these children
running around, screaming, yelling, not wanting to go to bed when
they need to, and our older adults were very frustrated by that. So
that is something that at a local level we really need to take a closer look at to see how we can address that from the local standpoint.
The CHAIRMAN. That is very good. I appreciate so much from
both of you.
Now, Susan Waltman may have another take on how to deal
with human disasters.

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STATEMENT OF SUSAN C. WALTMAN, SENIOR VICE PRESIDENT
AND GENERAL COUNSEL, GREATER NEW YORK HOSPITAL
ASSOCIATION, NEW YORK, NY

Ms. WALTMAN. Thank you very much for the opportunity to appear before you today. I am Susan Waltman. I am senior vice president and general counsel of the Greater New York Hospital Association. We represent 250 hospitals and long-term care facilities in
the New York City region. We believe that the issues that you are
examining today are very important. While many of us spend a lot
of time on emergency preparedness, Hurricane Katrina in its aftermath demonstrated quite vividly and in real time how there are
very disparate abilities and needs of various populations to participate in and gain the benefit of even the best of emergency plans,
and evacuations in particular.
We have, obviously, approached preparedness from the standpoint of hospitals, as those facilities that we represent and those
we think would be most called upon to prepare for disasters. But
we also recognize that what we doand we are hopeful that that
is the casecan apply to many other regions of the country as well
as to how we can better care for special needs populations as well.
I would like to just review what our framework has been. It is
one that we believe is billed upon an already very strong regional
framework for preparedness that exists in the New York City region. It is one that we think focuses very heavily on ongoing preparedness, where we really pay attention to and we learn from
every event alert in an emergency. It is a very collaborative approach, one where we are preparing everyday with what we call
our partners in preparedness, and all other kinds of providers, as
well as local, state and federal governmental agencies.
I will go through very quickly what we view as our guiding principles in that regard.
We view ourselves as being in a very high-risk region. That is
true for other areas of the country as well, for different reasons. We
have experienced, as you well know, two separate attacks on the
World Trade Center. We went through four different anthrax attacks, and we are very aware, very cognizant, everyday that we are
on the list of other high-risk targets as well.
We also recognize that we can experience natural disasters as
well. We experience hurricanes and plan for them as well, and we
know that we, as somewhat the gateway to the rest of the world,
can experience infectious diseases as being the front line, for example, and we prepare for pandemic influenza, which we are spending
a lot of time on right now.
So we live everyday and we try to do it with a sound mental
health approach as well, as though we could experience an emergency at any time. We do that through what we refer to as a very
strong three-way partnership among providers. In our case, it
might be human service agencies for another circumstance. But
there is a three-way partnership among providers, the health and
public health agencies, and the emergency management agencies.
We cannot prepare in isolation or we would end up really not
knowing what the other party can do for us or what we can do for
them.

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I think the two ways that gets demonstrated in the New York
City region is that we, for many years, have actually had a seat
at the New York City Office of Emergency Managements Emergency Operation Center. We, Greater New York Hospital Association, sit there as though we are a public agency, and we are
grouped with the other health and medical agencies, such as the
city and state health departments, the EPA, et cetera, so that we
can interact with them, give them assistance, and they can give our
own members and other healthcare providers assistance as well.
We also have put together since September 11, what is referred
to as an Emergency Preparedness Coordinating Council. There are
many task forces that bring together these three partners that different groups have put together. Ours is obviously from the provider prospective, but we have forced, so to speak, the issue of
bringing everybody to the table. We have literally met, or had a
work group, or had a conference call, every single week I would say
since 9/11, all with the aim of improving and enhancing preparedness among these three parties. I do suggest that it could differ for
human services. For example, the replacement in terms of providers would be human service agencies with the relevant local
agencies and emergency management agencies.
We subscribe, as you have heard today, to an all-hazards approach. We to, after 9/11, looked very hard at anthrax and smallpox, but then we took a very quick deep breath, and we said lets
have an all hazards approach, so that we can respond to any type
of emergency, and then fit in the hurricane plan, the pandemic influenza pan, et. cetera. As part of that, we subscribe very heavily
to incident command systems, so that we can better prepare internally, talk to other providers, as well as other agencies, so we are
talking the same language as we respond, and everybody has a better sense of their role.
There is very heavy emphasis, as you have heard, on communications. We look at that from two perspectives. We need to know very
clearly with whom, how, and for what? We need to communicate
before a disaster so that we have all the information we need. The
partners, our patients, our clients would be the translation before
that disaster occurs, so we do not need toas the Deputy Commission of OEM sayschange carts in the midst of a disaster. We also,
obviously, have built in redundant communications as well; how
does that get demonstrated? We have an extensive emergency contact directory about all of our members, how to reach the chair of
the disaster committee, the administrator on call, the Emergency
Operation Center, and every single one of our members from basic
phone lines to ham operators. It goes all the way down.
We have very extensive ways to communicate with members
through e-mail alerts. We have 800 mega hertz radios that connect
the hospitals and the nursing homes with us and the Office of
Emergency Management. We have a web site that is opened to the
publicit is not something that is just for members onlythat
gives extensive information, focusing particular on services and information for the community at large, for the public, in terms of
their own preparedness.
What we have also developed, and we neededand I just want
to say, you did not ask me about lessons learned, but almost every-

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thing that you are hearing in terms of what we have put in place
is because we learned lessons. We paid attention to what we
needed and what we recognized that we needed during the course
of 9/11 and the months afterwards. It was a good way to identify
common elements that we needed, data elements, information
about an emergency, so we can manage an emergency betterdata
elementsas well as an efficacious way of collecting that information.
So we worked with our state health department, and we have
created the Health Emergency Response Data System, which is
housed on the states health provider network in a secure Internet
site, that allows us to communicate information about our needs,
as well as what we can offer during a disaster. It has many different templates that can be used in terms of beds, staffing, availability, and what is being experienced during a particular event.
We also build inbecause we needed it on 9/11a patient location
system. We practice and we use it weekly. We have drills, and it
is able to be used for many types of providers, and I think it has
become a very valuable tool for managing emergencies.
We really feel very strongly that we have to understand each
others roles and responsibilities again. That is all a part of this
three-way partnership. In order to do that, we plan and we drill
together as we develop a plan on threat-alert guidelines, on hurricanes, on pandemic influenza. We have all of the parties at the
table, so we make sure that it works. We might spend two meetings on the first step because we need to understand better who
takes charge, who is on the site, who will communicate with whom,
and the rest does flow from that, but we undertake very collaborative planning. Training and education is very important as well.
Interestingly, on the issue of providers, first responders families,
we just undertook a survey of what training our members still
needs. It is very much on household preparedness, so that our own
healthcare workers will feel comfortable showing up for work during an emergency.
I have gone through our guiding principles for preparedness in
general. We have subscribed to them as a region and as a state,
and have looked at how we can better care for our special needs
populations. I think the city and the state have done that very well
to date, but we recognize we need to do much more. Already we
have participated in and have arranged for a number of meetings
to look hard at evacuation plans. The state, city and we are looking
at putting together templates for evacuation plans for nursing
homes and a variety of other types of providers, as well as the type
of information that every kind of agency should be collecting about
its own patients and their clients, so they can all reach them, as
you have heard, in advance and during a disaster, and understand
their special needs and be able to share that information so people
can be adequately cared for and evacuate. We do, obviously, subscribe to individual preparedness. I think that enables the individual, whether they are an older American or someone else, to
avail themselves of the plans that do exist, but we do take charge.
We do believe that the agencies have responsibility for making sure
that their clients are well taken care of.

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We think a lot of what we have done can be expanded to other
regions on caring and planning for special needs populations. We
offer, obviously, to make anything that we have done, any of these
lessons we have learned, sometimes the hard way, available to others.
[The prepared statement of Ms. Waltman follows:]

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115
The CHAIRMAN. Susan, obviously, after 9/11 and Katrina, we in
government and in the private sector have to begin imagining the
unimaginable. Did you see a substantial increase in your preparedness after 9/11 or was it in place after the first bombing of the
World Trade Center?
Ms. WALTMAN. I think we have historically had a very strong regional planning approach in New York City because of the initial
World Trade Center attack, as well as the large events that we
host in our small town of 8 million people. But there is no question
that we have spent an awful lot of time since 9/11. I think we realized that we are very much a target, and that we need to do even
more collaborative planning.
I think, as I said, that everything that you have heard we have
put together, we have done so with hindsight and of the experiences that we have seen. We also have tried very hard not to experience a failure of imagination, as the 9/11 Commission says, so we
have thought very hard about things we have not yet experienced
and that might occur, and I think that has informed us tremendously.
I just want to say one last thing. Mayor Bloomberg has made the
point in terms of special needs populations, that no one will be left
behind. Certainly, that is going to be a very hard task to accomplish, but I think if we go out everyday as we prepare, I think we
are better at making sure that we think of all the special needs
populations, and older Americans in particular.
The CHAIRMAN. Can the abandonment of elderly and disabled
people cannot happen in your area?
Ms. WALTMAN. I think it can happen. I think we are, with all deliberate speed and efforts, trying to make sure that it does not happen. I think that will mean an expansion of our collaborative planning. I know that the Office of Emergency Management plans to
include more agencies potentially in an OEM activation so that we
cannot have, or we are less likely to have, what occurred. Again,
that gets back to learning lessons and paying attention to everything.
The CHAIRMAN. I remember being in New York a few days after
9/11, and we spent some time on a huge hospital ship that had
come in to take care of the injured, but there were no injured.
There were, frankly, few survivors. They were, obviously, injured,
but not what had been planned for.
I guess my question, then, becomes, your system is very much an
urban system. Yet, you say you have a model that you think is
adaptable to other areas. How is it adaptable to more rural states?
Ms. WALTMAN. I think that the essence of the plan is collaborative planning, is making sure that the private and public agencies or authorities that are responsible for individuals come together. I think that it is so easy to engage in silo approaches, stovepipe approaches, whether you have an urban area or a rural area.
I do say in the written testimony, it does not matter who takes
charge in a particular community, rural or urban; you have to have
a champion. Maybe it is going to be the private sector that comes
forward and forces, as I said, people to come to the table. But you
can engage in collaborative, everyday planning no matter where
you are. I do think there are some very basic principles in terms

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116
of communications and all hazards that can apply no matter where
you are.
The CHAIRMAN. Well, you are all to be congratulated on the work
that you do, the programs that you run, and the care that you provide. We really appreciate your presence here today, what you have
done to highlight the importance of both private and public sector
collaboration. We have to do better. Experience is a hard task master, and the lessons learned are lessons we want to highlight.
I want to express, on behalf of the senior population of which I
am quickly becoming a member, we appreciate your focus on the
special needs of the elderly. Ours is an aging nation, so their needs
are, frankly, all of our needs. With that, our heartfelt thanks. This
hearing is adjourned.
[Whereupon, at 12:11 p.m., the committee was adjourned.]

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APPENDIX
PREPARED STATEMENT

OF

SENATOR HERB KOHL

We thank our Chairman, Gordon Smith, for holding this hearing on emergency
preparedness planning for seniors, and for his leadership on this and countless
other important issues facing older Americans.
Emergency preparedness planning is a challenge under any circumstance. Preparing for the unique needs of the elderly requires even greater diligence and resolve. As we have seen in the aftermath of Hurricanes Katrina and Rita, disasters
have an exaggerated effect on seniors, in particular those who depend on others for
assistance in their daily lives. The ongoing provision of evacuation transportation,
food, medication and shelter all become life and death matters.
This does not even speak to the tragedies we recently witnessed in the abandonment of the disabled and elderly in nursing homes, hospitals and other care
facilities- the institutions which we would assume would be most vigilant in emergency preparedness and caring for our most vulnerable. In this regard, I have asked
the Inspector General of the Department of Health and Human Services to conduct
a thorough investigation into federally mandated evacuation plans for nursing
homes and hospitals to determine the adequacy and shortcomings of those plans in
place.
As we have learned from past disasters and attacks, a multidisciplinary approach
on the federal, state and local levels is needed to properly guarantee that the needs
of our seniors are addressed. Today, the Committee will hear from a panel of experts who will tell us just how to do this. We look forward to hearing from and
working with them to ensure that in the face of future disasters, our seniors remain
healthy, safe and secure.
Thank you Mr. Chairman.

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